Healthcare Provider Details

I. General information

NPI: 1184696817
Provider Name (Legal Business Name): KRISTIN S RISCHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 3RD AVE
CORDELE GA
31015
US

IV. Provider business mailing address

PO BOX 5007
CORDELE GA
31010
US

V. Phone/Fax

Practice location:
  • Phone: 229-271-2229
  • Fax: 229-276-3633
Mailing address:
  • Phone: 229-271-4656
  • Fax: 229-276-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041962
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00715327A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: